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Background and Aims: Obstetric quality of recovery score-11 (ObsQoR-11) was developed in English to evaluate the quality of recovery in the caesarean section. We aimed to validate the Hindi version of ObsQoR-11 (ObsQoR-11H) for Hindi-speaking patients to evaluate the quality of recovery following the elective caesarean section. Methods: The ObsQoR-11 was translated into Hindi and assessed for validity, acceptability and feasibility. The questionnaire was administered postoperatively at 24 and 48 hours, and the Global Health Numeric Rating Scale (NRS) was used to evaluate recovery. Results: The mean (standard deviation [SD]) (95% confidence interval [CI]) ObsQoR-11 H was 75.94 (4.09)(95% CI 75.1, 76.7) and 80.25 (4.08)(95% CI 79.5, 81) at 24 and 48 hours, respectively. The mean (SD) (95%CI) Global Health NRS scores were 71.22 (5.97)(95% CI 70, 72.4) and 77.37 (5.79)(95% CI 76.2, 78.5) at 24 and 48 hours, respectively. Convergent validity showed a strong correlation between ObsQoR-11H and Global Health NRS (Spearman's correlation coefficient [rs] >0.8 and 0.78) scores at 24 and 48 hours, respectively. Discriminant validity was significant in appreciating the difference between good and poor recovery (P < 0.001). Split-half coefficient of 0.69 and 0.65 and Cronbach's alpha (α) of 0.91 and 0.82 at 24 and 48 hours suggested good score reliability. The acceptability and feasibility of the score were also good. Conclusion: The ObsQoR-11H discriminated well between 'good' and 'poor' recovery and correlated strongly with Global Health NRS scores. It was found to be a valid, reliable, acceptable and feasible tool for psychometric recovery evaluation after elective caesarean section in Hindi-speaking women.

Fascia iliaca block (FICB) has been used to reduce pain and its impact on geriatric patients with hip fractures. We conducted this meta-analysis to investigate the analgesic efficacy of this block in comparison to standard of care (SOC) when performed by non-anesthesiologist in the emergency department. Search on PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane database for randomized and quasi-randomized trials were performed. The primary outcome was to compare pain relief at rest at 2–4 h. The pain relief at various time intervals, reduction in opioid use, the incidence of nausea/ vomiting, delirium and length of hospital stay were the secondary outcomes studied. Trial Sequential Analysis (TSA) was performed for the primary outcome. Eleven trials comprising 895 patients were included in the meta-analysis. Patients receiving FICB had significant better pain relief at rest at 2–4 h with mean difference of 1.59 (95% CI, 0.59–2.59, p = 0.002) with I2 = 96%. However, the certainty of the evidence was low and TSA showed that the sample size could not reach the requisite information size. A significant difference in pain relief at rest and on movement started within 30 min and lasted till 4 h of the block. Use of FICB was associated with a significant reduction in post-procedure parenteral opioid consumption, nausea and vomiting and length of hospital stay. FICB is associated with significant pain relief both at rest and on movement lasting up to 4 h as well as a reduction in opioid requirement and associated nausea and vomiting in geriatric patients with hip fracture. However, the quality of evidence is low and additional trials are necessary. •Limited evidence on use of Fascia iliaca compartment block (FICB) in geriatric patientwith hip fracture by non-anesthesiologist•Search on four databases for randomized and quasi randomized trials yielded 11 trials comprising 895 patients.•Resting pain scores at 2–4 h was the primary end point.•FICB is associated with t pain relief lasting up to 4h along withand reduction in opioid requirement

To evaluate the effectiveness of subcostal TAP block and to compare its efficacy with that of posterior TAP block in decreasing postoperative pain in patients undergoing laparoscopic cholecystectomy during general anesthesia. Prospective, randomized, double-blind study. Academic medical center. 60 adult, ASA physical status 1 and 2 patients of both genders, aged 18-60 years, scheduled for elective laparoscopic cholecystectomy. Patients were randomized to three groups of 20 patients each. Group 1 patients received standard general anesthesia (control group); Group 2 patients received an ultrasound-guided posterior TAP block using 15 mL of 0.375% ropivacaine on each side; and Group 3 patients underwent a subcostal TAP block with 15 mL of 0.375% ropivacaine on each side. The presence and severity of pain during rest and movement, as well as nausea or vomiting and sedation, were assessed in all patients postoperatively on PACU admission, then at 2, 4, 6, 8, 12, and 24-hour intervals. Patients with a visual analog score (VAS) greater than 4, or those requesting analgesic were given intravenous tramadol 2 mg/kg as an initial dose; subsequent 1 mg/kg doses of tramadol, if needed, were given. Patients who received a subcostal TAP block had significantly lower pain scores at rest and on movement than the control group at all times postoperatively. Although, in the initial postoperative measurement times, the subcostal and posterior TAP groups had comparable pain scores, after 4 hours these scores were significantly lower in patients who had received the subcostal TAP block. For incisions mainly involving the supra-umbilical region, subcostal TAP block may be a better alternative than the posterior approach for providing postoperative analgesia.

Percutaneous endoscopic lumbar discectomy is increasingly gaining recognition as an alternative to open microdiscectomy for the treatment of intervertebral disk herniation. Apart from the neuraxial blockade, and general anesthesia, there is literature demonstrating the performance of endoscopic lumbar discectomy under sole local anesthesia infiltration. This is particularly advantageous as an awake patient assists the surgeon by verbalizing and preventing any inadvertent nerve root damage. However, marked pain has been reported during key steps such as endoscope port installation and radiculolysis. The erector spinae plane (ESP) block is an interfascial paraspinal block that soaks the spinal nerve roots with epidural spread providing superior analgesia for endoscopic discectomy. The utility of ESP block as a perioperative analgesic technique following spine surgery is well established; there are no reports of successful endoscopic discectomy performed using this block. This article emphasizes the utility of ESP block as the sole anesthetic technique for minimally invasive spine surgery in the awake state.

ABSTRACT With the increasing number of critically ill patients being admitted to intensive care units (ICUs), newer techniques and treatment modalities continue to evolve for their adequate management. Thus, it has become imperative to understand existing tools and resources, and utilise or repurpose them to achieve better results that can decrease morbidity and mortality. In this writeup, we chose five areas of interest, including analgosedation, role of colloids, recent advancements in the management of respiratory failure, the role of extracorporeal membrane oxygenation, and newer antimicrobials. The role of analgosedation in the critically ill has gained importance with focus on post-ICU syndromes, and albumin has re-entered the fray as a possible repairer of the injured glycocalyx. The coronavirus disease 2019 (COVID-19) pandemic forced us to relook at various ventilator strategies and mechanical support for the failing circulation has now become more common with clear end-points. Rising microbial antibiotic resistance has opened up the research on newer antibiotics.

Thoracic paravertebral block (TPVB) for breast surgery reduces acute and chronic postoperative pain. Using ultrasound for administering the block makes it easier, with its administration at multiple levels decreasing the number of unblocked segments. We conducted this study to evaluate the efficacy and safety of single- vs double-level ultrasound-guided TPVB in patients undergoing total mastectomy with axillary clearance under general anesthesia. This is a prospective, randomized study. Recovery room and operation theater. Sixty ASA I and II patients, aged 18 to 60 years, who were scheduled to undergo total mastectomy with axillary clearance under general anesthesia were enrolled in the study. Patients received either single- (group S) or double-level (group D) ultrasound-guided TPVB at T4 or at T2 and T5 levels, respectively, using 0.3 mL/kg of 0.5% ropivacaine. Primary outcome measure was 24-hour analgesic consumption, and secondary outcomes included number of segments blocked, postoperative pain scores, time to first request for rescue analgesic, and any side effects. The mean total amount of rescue analgesic given in group S was 175.3 ± 70 mg and in group D was 115.7 ± 48 mg (P = .002). Median number of segments showing less sensation to pinprick was 3 in group S and 4 in group D (P < .001). The mean time to first request for rescue analgesic was 533 ± 124 minutes in group S and was 611 ± 214 minutes in group D (P = .118). Patients receiving double-level TPVB had significantly less 24-hour analgesic consumption in the postoperative period than those in the single-level TPVB group. This could be due to decreased pain sensation to pinprick in significantly greater number of segments in the double-level TPVB group. •We evaluated efficacy and safety of single- vs double-level ultrasound-guided TPVB in patients undergoing total mastectomy.•Patients received either single- or double-level, ultrasound-guided TPVB at T4 or at T2 and T5 levels, respectively, using 0.3 mL/kg of 0.5% ropivacaine.•Median number of segments showing less sensation to pinprick was 3 in group S and 4 in group D (P < .001).•The mean total amount of rescue analgesia given in group S was 175.3 ± 70 mg and in group D was 115.7 ± 48 mg (P = .002).•Patients receiving double-level TPVB had significantly less postoperative analgesic consumption.

Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially in morbidly obese patients. The present study aimed to determine the efficacy of different sonographic measures as predictors of difficult laryngoscopy in morbidly obese patients undergoing elective surgery. This observational study evaluated 70 morbidly obese adult patients (body mass index >35 kg/m ) undergoing elective surgery under general anaesthesia with tracheal intubation. Pre-operative clinical and ultrasonographic variables (anterior condylar translation, tongue thickness, hyomental distance and oral cavity height) associated with difficult direct laryngoscopy ([Cormack Lehane (CL) grade>2]) were analysed. The primary outcome was to determine the efficacy of the above-mentioned sonographic measures as predictors of difficult laryngoscopy (CL grade >2). The secondary outcome compared ultrasonographic predictors with clinical predictors in morbidly obese patients for determining difficult direct laryngoscopy. Amongst the primary outcome measures, limited condylar mobility (anterior condylar translation <9.25 mm) [odds ratio (OR) 0.3, confidence interval (CI):1.04-1.22; <0.001;area under curve (AUC):0.8] and increased tongue thickness >5.85 cm [OR: 3.2, CI: 1.05-10; < 0.04; AUC: 0.73] were two independent sonographic predictors for difficult direct laryngoscopy by multivariate logistic regression and receiver operating characteristic curve analyses in morbidly obese patients. The secondary outcome suggested that as compared to clinical predictors such as Mallampati grade and thyromental distance, ultrasonographic variables such as tongue thickness and limited condylar mobility (sensitivity: 56.4%, 70.9%, 66.7% and 93.3%, respectively) better predicted difficult direct laryngoscopy in morbidly obese patients. Limited condylar mobility and increased tongue thickness are independent sonographic predictors of difficult direct laryngoscopy in morbidly obese patients.

The perioperative anaesthetic management of a case of COVID-19 pneumonia with multiple systemic comorbidities, posted for unilateral below knee amputation and debridement of hand, poses a uniquely challenging scenario for the anaesthesiologist. We hereby report such a case which was managed successfully using ultrasound-guided popliteal and wrist block along with perioperative use of high flow nasal cannula, incentive spirometry and awake proning.

Background and aim Probiotics have been linked to improved gastrointestinal health and essential nutrient absorption. This study aimed to assess the impact of ( ) UBBC-07 plus whey protein supplementation on the bioavailability of circulating essential amino acids (EAAs) in physically active young adults.  Methods In this double-blind, randomized, controlled trial, 70 physically active male participants (21.46±3.19 years) were instructed to ingest either a probiotic supplement containing two billion colony-forming unit (CFU) UBBC-07 + 20 g of whey protein or a control supplement containing placebo + 20 g of whey protein once daily for 60 days. All the participants followed a supervised exercise protocol. The circulating amino acid levels were determined using a high-performance liquid chromatography with fluorescence detection (HPLC-FLD) assay and compared using the student's t-test and a repeated measures analysis of variance (ANOVA). Results After 60 days, a significant improvement in the probiotic group was observed compared to the control group in terms of total levels of circulating EAAs (mean change: 258 pmol/μl, 95% CI: 161.5-354.4 vs. 76.4 pmol/μl, 95% CI: 16.5-136.4; p=0.002) and branched-chain amino acids or BCAAs (mean change: 144.2 pmol/μl, 95% CI: 89-199.3 vs. 37.5 pmol/μl, 95% CI: 7.3-67.8; p=0.001) as well as levels of isoleucine (p=0.003), leucine (p>0.001), and valine (p=0.001). Total plasma free amino acids (PFAAs) were also increased in the probiotic group (p<0.001). The improvement in the one-repetition maximum (RM) leg press was higher in the probiotic group as compared to the control group (mean change: 20.46 kg, 95% CI: 14.73-26.19 vs. 14.09 kg, 95% CI: 8.44, 19.73; p=0.045). A trend towards improvement in deadlift and vertical jump was also observed in the former group. No probiotic-mediated gastrointestinal upsets and respiratory symptoms or any other adverse events were observed. Conclusion A significant improvement in circulating EAA levels in the probiotic group suggests an enhancement of protein absorption with UBBC-07 supplementation. The effect of BCAAs, which enhance muscle strength, is evident in the significant improvement in leg press and a trend towards improvement in deadlift and vertical jump in the probiotic group. This has positive implications for individuals involved in sports activities.

Background and Aims: Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially in morbidly obese patients. The present study aimed to determine the efficacy of different sonographic measures as predictors of difficult laryngoscopy in morbidly obese patients undergoing elective surgery. Methods: This observational study evaluated 70 morbidly obese adult patients (body mass index >35 kg/m2) undergoing elective surgery under general anaesthesia with tracheal intubation. Pre-operative clinical and ultrasonographic variables (anterior condylar translation, tongue thickness, hyomental distance and oral cavity height) associated with difficult direct laryngoscopy ([Cormack Lehane (CL) grade>2]) were analysed. The primary outcome was to determine the efficacy of the above-mentioned sonographic measures as predictors of difficult laryngoscopy (CL grade >2). The secondary outcome compared ultrasonographic predictors with clinical predictors in morbidly obese patients for determining difficult direct laryngoscopy. Results: Amongst the primary outcome measures, limited condylar mobility (anterior condylar translation <9.25 mm) [odds ratio (OR) 0.3, confidence interval (CI):1.04-1.22;P<0.001;area under curve (AUC):0.8] and increased tongue thickness >5.85 cm [OR: 3.2, CI: 1.05-10; P < 0.04; AUC: 0.73] were two independent sonographic predictors for difficult direct laryngoscopy by multivariate logistic regression and receiver operating characteristic curve analyses in morbidly obese patients. The secondary outcome suggested that as compared to clinical predictors such as Mallampati grade and thyromental distance, ultrasonographic variables such as tongue thickness and limited condylar mobility (sensitivity: 56.4%, 70.9%, 66.7% and 93.3%, respectively) better predicted difficult direct laryngoscopy in morbidly obese patients. Conclusion: Limited condylar mobility and increased tongue thickness are independent sonographic predictors of difficult direct laryngoscopy in morbidly obese patients.